The Truth About Foreign Health Care
Number 2 tram in Amsterdam (my photo)
Mitch McConnell was on the floor of the Senate the other day droning on about the nightmare of rationing and Soviet-style bread lines that are sure to result from the government guaranteeing affordable health care for everyone. Meanwhile, Jonathan Cohn actually traveled to foreign countries—specifically France and the Netherlands—to check out their health care systems. He reports that things are pretty awesome:
But in the course of a few dozen lengthy interviews, not once did I encounter an interview subject who wanted to trade places with an American. And it was easy enough to see why. People in these countries were getting precisely what most Americans say they want: Timely, quality care. Physicians felt free to practice medicine the way they wanted; companies got to concentrate on their lines of business, rather than develop expertise in managing health benefits. But, in contrast with the US, everybody had insurance. The papers weren’t filled with stories of people going bankrupt or skipping medical care because they couldn’t afford to pay their bills. And they did all this while paying substantially less, overall, than we do.
It’s also really important to just make a simple conceptual point. Right now health care is rationed by your ability to pay. And under any even remotely plausible vision of health care reform for the United States it would continue to be the case that people with the means and desire would be able to pay doctors to do pretty much whatever. Insofar as any “rationing” would take place at all it would be in terms of what the government is prepared to pay for.
43 Responses to “The Truth About Foreign Health Care”
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July 6th, 2009 at 4:45 pm
Someone should ask Mitch McConnell if we’re turning into the Soviet Union if it’s responsible for him to be a high official in the new government.
July 6th, 2009 at 4:55 pm
While playing around with the Wolfram thing, I found this:
“Life Expectancy japan”
bottom 1% | 29.45
bottom 5% | 55.42
bottom 10% | 64.67
bottom 25% | 77.02
“Life expectancy usa”
bottom 1% | 16.27
bottom 5% | 46.09
bottom 10% | 56.99
bottom 25% | 70.79
I think it’s interesting that in Japan even a worst-case scenario for your lifespan is almost twice as good as in the US, at least for the 1% of people who are unhealthiest.
July 6th, 2009 at 5:09 pm
U-S-A! U-S-A! has gone from a cheer to religious dogma. We are number one in everything, and only evil people do not recognize that fact.
A country that actually believes that (a minority does, but only a minority)is headed for doom at supertrain speed.
July 6th, 2009 at 5:12 pm
The ability to pay isn’t the only cause of rationing. What do people think the M in HMO really stands for?
July 6th, 2009 at 5:20 pm
Matt,
I am all for rationing health-care based on government / expert determination as to what maximizes the best possible outcomes for society as a whole. The problem is that we on the left have not yet figured out how to sell this to the majority of the population which has coverage.
And while the more enlightened of us with jobs and health coverage still see the untenable situation we are in now (as well as the unfairness and surprisingly, competitive disadvantage it puts us in compared to other countries), the majority of moderate Dems have constituents which are of the same mind as the recession/depression determination:
“It is a recession when my neighbors lose their job, it is a depression when I lose my job”.
Ben Nelson unfortunately have a lot of people who gauge the quality of any system/program based entirely on the anecdotal experience they personally have and nothing else.
July 6th, 2009 at 5:22 pm
Right now health care is rationed by your ability to pay.
This point cannot be made too often. Which is why I’m repeating it. (And daveNYC is right, too.)
July 6th, 2009 at 5:36 pm
Mitch McConnell can’t imagine a health insurance program rationing care.
Of course, that’s because he’s spent most of his adult life on a public health care program.
July 6th, 2009 at 6:11 pm
It is very illustrative that everybody, rich and poor, signs onto Medicare as soon as they are eligible. They don’t have to…
July 6th, 2009 at 6:12 pm
What Cohn can’t convey personally is the actual lived experience of being sick outside the US.
That goes beyond the classic tourist anecdote of “I tripped over in Paris, got sorted out in the emergency room, they looked oddly at me when I tried to pay.” Not having to spend days trying to get a phone drone to say, in advance of a test, whether it would be covered. Not having to second-guess a doctor’s recommendation because you haven’t reached your deductible. Not having to consider whether you want a particular ailment go on your record in the event of it coming back to haunt you as a pre-existing condition. Not having six bills with 32 line items for one visit to the E.R.
As TR Reid noted, the first instinct of the Taiwanese health reformers was to look to the US — after all, lots of rich Americans with gold-plated insurance plans say it’s the best in the world. And foreigners go there when they get sick! What they saw was that there is no system, just a market that delivers care to the wealthy elect.
Of course, that’s because he’s spent most of his adult life on a public health care program.
There really needs to be a Wiki thing to work out just how many Senators have, post-college, spent their entire lives as members of either federal or state health pools.
July 6th, 2009 at 6:29 pm
http://www.nationmaster.com/graph/hea_obe-health-obesity
On a side note, maybe states on the border with Canada should pay Canada to use it’s wildly efficient an cheap hospitals.
Ohh that’s right, Canada is already sending thousands south to get basic care for cancer.
July 6th, 2009 at 6:36 pm
I am all for healthcare reform of the variety being touted. I am frustrated by the unwillingness of the reformer’s to address the need for tort reform as I perceive it. After all, in Europe isn’t part of the reason doctors feel comfortable practicing medicine the way they want to is that they don’t have to fear punitive damages and don’t have to pay frighteningly high levels for malpractice insurance.
Taking money from trial lawyers may be a political necessity for Democrats making tort reform infeasible at this point in time, but I’d like to see Yglesias and other pro reform supporters discuss it more and not just waive it away.
Health Care costs have not been going up because doctors have are being paid more and more. Reform will inevitably reduce doctor’s compensation even more. Why not throw them a bone, lest you make the prospect of becoming a physician less appealing.
July 6th, 2009 at 7:01 pm
After all, in Europe isn’t part of the reason doctors feel comfortable practicing medicine the way they want to is that they don’t have to fear punitive damages
I don’t understand the history behind America’s different view of civil damage awards. As I understand it, damage awards in Europe, including the UK, are much lower than in the US. This goes for all kinds of civil cases, hit someone with your car in the US your insurance could pay 25k to 100k in Germany such a judgement would rarely reach EUR5000.
Does anyone have an insight into why the two approaches are so different? I’d say is has to do with our common law heritage but judgements in the UK are low like the rest of Europe.
July 6th, 2009 at 7:22 pm
Does anyone have an insight into why the two approaches are so different?
I imagine it’s because better safety nets minimize some of the lifelong devastation of medical injuries… keep in mind that a lot of the bigger US awards are meant to compensate for lost future earnings and the costs of medical care, both of which are better covered (socialism!) in other developed nations. Plus, IIRC the doctors most likely to get sued here seem to be assholes who refuse to admit errors, and I’d guess that particular brand of arrogance could be linked to making truckloads of money. Of course, that last bit’s just speculation on my part, but we do have a big-money culture in medicine here that seems to draw some real jerks.
I’m sure more wonkish types will have some info on evidence-based care not only being more generally effective, but also providing a much better defense for medical professionals who do follow standard protocols. Again, it’s a cultural thing, and IMNSHO supports the idea that medicine ain’t the place for the planned disasters of capitalism.
July 6th, 2009 at 7:34 pm
Back when Matt was in Amsterdam he sure took a lot of pictures of the Queen’s road (Koninginneweg). Which happens to be where I live.
One of queen Beatrix’ nephews (prince whatever, I’m not much into our royalty) supposedly lives in the middle house behind the tram.
July 6th, 2009 at 7:40 pm
Ohh that’s right, Canada is already sending thousands south to get basic care for cancer.
And pays for it. What’s your point, insurance lackey? Canadian right-wingers aren’t going to touch the fundamentals of their system, because for every scare story about Canada in the US press, there are a thousand medical bankruptcies south of the border to remind Canadians that while it isn’t perfect, they’d sooner give up hockey than Medicare.
July 6th, 2009 at 8:02 pm
Actually Nathan, Canadians coming across the boarder for health care are a rare phenomenon. Someone did a study and counted them up. If I remember, I’ll post the study which I have bookmarked after I get home tonight. It turns out that Canadian wait times for elective procedures are pretty damn good too.
July 6th, 2009 at 8:02 pm
Health Care costs have not been going up because doctors have are being paid more and more. Reform will inevitably reduce doctor’s compensation even more. Why not throw them a bone, lest you make the prospect of becoming a physician less appealing.
According to Dean Baker American doctors are wildly overpaid compared to their European counterparts.
If med school is cheap/free (for students if not for society), you can select plenty of smart people who want to be doctors and are prepared to work for ‘only’ upper middle class salaries. You end up with more and cheaper doctors.
July 6th, 2009 at 8:08 pm
American doctors are wildly overpaid compared to their European counterparts.
As are nurses and lab techs.
Perhaps we are paying fairly and Europeans are being underpaid?
Just a thought.
July 6th, 2009 at 8:22 pm
“Canada is already sending thousands south to get basic care for cancer.”
Which is ironic because we send even more people south into Mexico. Canadians shouldn’t waste their money on treatment in the US. You can get the same care in Thailand at a tenth the cost. In fact, for major procedures, Americans with health insurance should also go to Thailand. Paying cash in Thailand is about the same cost as paying your co-pay in the US. I’ve met several people who were in Bangkok for medical procedures even though they had insurance in America. It was still cheaper to fly halfway around the world. And a lot less hassle.
July 6th, 2009 at 8:32 pm
Perhaps we are paying fairly and Europeans are being underpaid?
Perhaps soccer is boring and the rest of the world just hasn’t realized yet.
Just a thought.
July 6th, 2009 at 8:33 pm
It’s even more stark than that
Right now, the non-system of private health insurance we have in this country is doomed, walking dead. Right now, almost any person who buys individually on the market, is making a clear mistake, based purely on economic calculation. He or she would be much better off self-insuring, salting away as much as they can, less than the premiums they can’t afford anyway, but at least several hundred a month. From that, they would pay out of pocket for any medical services needed. Barring a medical catastrophe, they will do much better than paying for insurance. And in the case of a catastrophe, a family member diagnosed with leukemia, for example, with or without insurance, they’re going bankrupt anyway, such is the crappiness of the product the privates have on offer. Group insurance both gets a somewhat better price, and gets the tax exemption, so it is not as immediately threatened, but the same overall dynamic applies. More and more of the people hemorrhaging out of private insurance today are opting out to self-insure/not insure, and aren’t leaving because they’re being forced out as bad risks. That adds to the vicious cycle, as the departure of these good risks raises the premiums that must be charged even further.
The fact that we have so many uninsured is not the crisis we are facing now in health care financing. Sure, it’s a moral disgrace that we don’t insure everybody, but we crossed that ethical bridge a long time ago, and it’s hardly a new, crisis, developement. The crisis is that private insurance is going belly up, becoming unsustainable. Reform isn’t the enemy of the privates, it’s the only prospect they have to survive. They have to get changes that give them a massive subsidy from the taxpayer, or they will go out of business. Progressives should not be railroaded into supporting any reform that doesn’t kill the private insurers. All we have to do is block any bad reform, any reform that would throw them a lifeline, and nature will kill them off for us in short order. End the tax exemption and they die sooner.
July 6th, 2009 at 8:41 pm
“Perhaps soccer is boring and the rest of the world just hasn’t realized yet.”
I won’t speak to whether doctors are overpaid or not*, but this is definitely true.
*I would think it’s really a question of how attractive you want to make the profession, but that’s just a hunch.
July 6th, 2009 at 10:36 pm
Glenn Tomkins
Totally agree with every sentiment, concept, and argument in your post. Thank you.
As for McConnell, what the hell is he talking about? I hope he wasn’t comparing our health care system to the old Soviet-style health care system, because the dirty commies did pretty fucking good in that department. Superior, at least, to our current abilities, that’s for sure.
If he was just talking specifically about commie ineptitude in the agricultural sector, ok, I will give Madman Mitch a pass. Soviet supermarkets certainly left a little something, something to be desired -like stocked shelves.
July 6th, 2009 at 11:49 pm
I am employed and my employer pays half my insurance. I pay 160 a month which means my health care is 320 a month for one person, me. I rarely go to the doctor because on top of my premium and copay (25) there are the test. The cheapest is 20 and up. The test are not covered under my BCBS plan. I have to pay and it invariable ends up another 65 to 100 on my doc visit. My doctor who I dropped and haven’t visited a doctor since over 8 months ago, always wants 3 to 4 test. He also sent me for a chest xray which turned out negative….don’t remember the final cost but it was it the several hundred dollar range, another non ailment – blood in my urine, which turns out is common, it was a cat scan and some uncomfortable procedure to look at my bladder…..over a 1000 I was left owing. Who can afford health coverage like that. I no longer go to a doctor even though I need to. Hail America!
July 7th, 2009 at 12:33 am
donna: you’re thinking, possibly, “is the doctor getting a kickback from the scanning center?” or “he’s just giving me the most expensive tests first” or “can I trust anything a doctor tells me?”
That’s not healthy, in all senses of the word.
Superior, at least, to our current abilities, that’s for sure.
Definitely superior to the Russians’. The 90s saw male life expectancy plummet in Russia (by about ten years, if I remember rightly).
July 7th, 2009 at 12:49 am
Um, so, isn’t this just a quick summary of Michael Moore’s Sicko in a less audio/visual format?
July 7th, 2009 at 2:52 am
I didn’t see any pushback against this hilarious AP story about scary European health care:
Europe’s free, state-run health care has drawbacks
http://www.google.com/hostednews/ap/article/ALeqM5jRH9HWyWEzTKMtInJchGBO1POSYQD997PUIG0
To get the joke, google the institutions where the “experts” quoted work. Every single one of them is a Cato-type free-market fundamentalist workshop.
July 7th, 2009 at 5:29 am
As are nurses and lab techs.
Perhaps we are paying fairly and Europeans are being underpaid?
Just a thought.
Becoming a doctor in the United States is a huge pain in the ass and requires you to throw aways your youth to little benefit (except the higher future pay). I can’t imagine how it’s ‘educating’ people to force them to work under conditions of sleep deprivation on a regular basis to qualify for the job. Sure ER requires continuity of care that recommends, therefore, longer working shifts. But it still doesn’t make sense that every doctor be obliged to survive 100 hour work weeks to qualify. There’s plenty about the medical profession in the United States that deserves an overhaul and the medical licencing program wouldn’t be a bad place to start.
July 7th, 2009 at 7:28 am
To try to reproduce France’s healthcare system in the U.S., the average pay of all healthcare workers would have to be lowered. How could the U.S. do this and since there are shortages now of pharmacist, certain nurses, and other allied healthcare workers, what would lowering pay do.
I can understand why the Ivy Leaguers want to turn health care workers into blue collar workers since the elite universities are rarely involved in training such workers and health care is a field where one is not paid more for being an Ivy League graduate. If there is a shortage of nurses in NYC now, image what is going to happen if you lower the pay.
July 7th, 2009 at 7:58 am
Perhaps we are paying fairly and Europeans are being underpaid?
Just a thought.
You have heard of this new science called economics, have you? There’s this law they’re onto, called “demand and supply” or something like it, which predicts that if you artificially create a shortage of a good (say, doctors) you can raise it’s price. What it also predicts is that when you underpay a profession people will leave that profession or go work somewhere else.
You must go talk with these eonomists types and tell them they’re wrong and that being underpaid actually attracts doctors to Europe while in the US there’s a shortage because salaries are just to fucking fair.
July 7th, 2009 at 8:54 am
Mr. Well-off has great health insurance for whatever reason. A large percentage of Americans don’t. When Mr. Well-off goes to the doctor’s office for a check up (covered under his great health insurance plan), his waiting time isn’t so long because a large percentage of Americans avoid going to the doctor when they are sick unless it is absolutely necessary since it is expensive.
If, however, a large percentage of Americans had insurance plans that covered check ups and took advantage of this coverage, then Mr. Well-off would find that his waiting time increases, all other things being equal. This would inconvenience Mr. Well-off, and he doesn’t like the thought of that, so he shouts “rationing” from the rooftops.
The same principle can be applied to every medical procedure.
July 7th, 2009 at 9:07 am
Erik – A substantial amount of the difference in life expectancy for the bottom 1% may be due to the different violent crime rates in the two countries.
July 7th, 2009 at 9:57 am
[...] Drum thinks someone should tell Max Baucus the truth about foreign health care: Now, the fact that the French spend about half what we do doesn’t mean that we’d cut [...]
July 7th, 2009 at 10:21 am
And we should ignore everything from CAP because it’s a left wing progressive think tank?
July 7th, 2009 at 11:31 am
When CAP has the same track record for massive dishonesty as does Cato and Heritage and the rest of the free-market fundamentalists – then yes. Until then, given that it has shown a much greater intellectual honesty than, for example, the nitwits claiming that Canada’s citizens are all streaming to the US for basic care, no.
July 7th, 2009 at 12:00 pm
my previous comment is languishing in moderation limbo:
Here’s the study that determined that only a tiny number of Canadians access American health care:
“http://content.healthaffairs.org/cgi/content/full/21/3/19″
Dean Baker claims that US docs are paid like CEOs. He’s got a bug up his butt about it, but he’s off by a couple of orders of magnitude. Here’s the OECDs numbers comparing US and western European incomes (actually, if you look at salaries in terms of average household incomes, they are roughly the same, France is an outlier because French docs get an enormous tax break compared to other French citizens):
“http://www.oecd.org/dataoecd/51/48/41925333.pdf”
And here’s the link for Canadian wait times as provided by a Conservative Senator:
“http://meanlittlepoodle.blogspot.com/2009/06/canada-fights-back-against-false-health.html”
European docs spend the same amount of time training as US docs.
July 7th, 2009 at 12:48 pm
If I see this thing about tort reform one more time, I will shake someone until their head snaps off. Texas had tort reform years ago so doctors don’t have to worry about anything. In the years since then, nothing has changed as far as malpractice premiums. (You think the insurance companies are going to REDUCE premiums!?) Doctors are still doing excessive testing. (For more on that see the report about the difference between McAllen and El Paso.) The reasons for that are that the doctors get their cut out of every test they order which makes it worth their while to pile it on. Tort reform is a red herring that has been thrown at a gullible public.
July 7th, 2009 at 1:20 pm
J Bean – thanks for the link to the OECD report. It shows that Dutch specialists are paid the best, and -surprise- Holland is also the country with the fewest doctors relative to population. Get rid of the barriers (the dreaded numerus fixus in Holland), and costs should come down.
July 7th, 2009 at 1:24 pm
Aussie health care (which is never mentioned) is uniformly excellent and should be the model Obama & Co. should adopt. Here, you’ve got an English-speaking country with a positive image. Just from a PR pov it’s a better fit to persuade all concerned.
July 7th, 2009 at 2:46 pm
First, a word about malpractice awards. The high requests, occasionally awarded, are the most publicized as being an outrageous example of how doctors and insurers are badly treated.
Yes, there are litigious people. But nearly all of these awards are reduced way down on appeal – a process which sometimes goes on for many years. Insurance rates for malpractice go up when their investments’ value goes down, so the awards aren’t the only determining factor.
Also to consider, there are cases, such as a patient being reduced to a vegetative state, where a family is obliged to sue in order to pay for necessary care. Not to be forgotten are the 100,000 or so cases of proven malpractice each year.
Second, in actively suppressing single-payer health care from consideration, the Democrats seem to have discovered a way to return the country to Republican hands next election. The proposals on the table are very expensive, and simply won’t suffice to solve our grave problem. They could begin by requesting the Congressional Budget Office to score single-payer, so the cost could be compared with other proposals. That would make it an interesting new ball game.
It wouldn’t hurt for people to ask congress critters for the CBO scoring. And, if you’re really fed up, join us in Washington D.C. on July 30th for a rally/lobbying day, and a celebration of Medicare’s anniversary, and of Rep. John Conyers’ efforts in promoting single-payer. Information available on Healthcare Now’ web site.
July 8th, 2009 at 12:00 pm
[...] Matthew Yglesias on the Cohn piece [...]
July 9th, 2009 at 4:29 pm
Last I checked, CAP was still claiming 45.6 million Americans didn’t have health care.
July 9th, 2009 at 4:30 pm
If you could go ahead and cite where CATO was dishonest I would love to read it.